On September 1st, 2021, Texas Senate Bill 8 went into effect. While the law’s stated goal is to severely limit a woman’s constitutional right to an abortion in Texas, it also designates private citizens to sue not just abortion providers, but anyone “aiding and abetting” a woman seeking to obtain an abortion after six weeks of gestation. If such a lawsuit is successful, the party bringing the suit can collect a $10,000 “reward” from the state. The law clearly seeks to intimidate anyone trying to seek or perform an abortion. However, it also has the effect of interfering with regular physicians for doing their job. Primary care physicians routinely counsel patients about reproductive health. If a vigilante decided that one of us was “aiding and abetting” a patient seeking an abortion, we could be in the crosshairs as well. It is for this reason that the law egregiously interferes with the sacred physician-patient relationship, and “places bounties on physicians and health care workers simply for delivering care,” as correctly noted by AMA president Dr. Gerry Harmond. The Texas Medical Association, traditionally a conservative organization, correctly noted that SB 8 “will be precedent-setting and could normalize vigilante interference in the patient-physician relationship in other complex, controversial medical or ethical situations.” As physicians, we cannot stand quietly by. Already, state legislatures in other conservative states are looking to follow Texas’s lead. We’ve stared down death and disability during COVID-19 pandemic, and we cannot let cynical politicians frighten us now. Our oath and medical code of ethics command that we provide the most evidence-based and compassionate care to our patients and communities. This means fighting both for what our patients need to lead their healthiest lives and what we need to be able to provide that care to them. So, what can we do? First, we need to get the best care for our patients. Given the very real threat to Roe v. Wade, we need to prevent more unintended pregnancies. To achieve this end, more primary care doctors should learn how to place and manage long-acting reversible contraceptives, or LARCs. A comparison of contraceptive options shows that LARCs are by far the most effective. Moreover, in countries where LARC usage is widespread, abortion rates drop. Yet the United States has the lowest adoption of LARCs of any industrialized nation, and one of the highest unintended pregnancy rates as a result. Recent studies have shown that while demand for LARCs in the US has steadily increased since the Affordable Care Act started requiring that the devices be fully covered, only 21 percent of family physicians regularly place IUDs and only 13.6 percent regularly place implants. A 2013 survey found that only 26 percent of internists and pediatricians combined were comfortable counseling, placing, and managing IUDs. By significantly increasing the number of physicians who can place and manage the devices, we can dramatically increase access to effective contraception and prevent unplanned pregnancies to begin with. Unfortunately, simply increasing access to LARCs will not prevent all unintended pregnancies, and we still need to protect the privacy of the physician-patient relationship, including counseling regarding abortion and access to quality abortion care. Therefore, the second thing we need to do is contact our lawmakers. Medical societies have messaging systems for members to contact legislators. If you are a member of a society, reach out to find out what is being done. If you are not a part of organized medicine, there is still a lot you can do. Find your local, state, and federal legislators by using a special search engine such as Common Cause, then call or write them. Point out that you are a medical professional, and explain how you feel about the intrusion into your ability to provide patients with safe care. Make it very clear where you stand on the importance of the physician-patient relationship and that doctors be able to give comprehensive care. Write out what you want to say first and then review it, checking to make sure you are coming across as reasonable and professional. Third, we need to remove elected officials who won’t prioritize science and the health of their constituents and elect people who do. We need to talk to our patients about the importance of voting and help them get registered if need be. Organizations like Vot-ER and Civic Health Alliance provide education on how to talk to patients about the connection between voting and their health, and toolkits to help patients get registered to vote during an office or emergency room visit. And in its “Prioritizing Equity” series, the American Medical Association featured a lecture discussing how improving access to voting is vital to reducing health inequity in American Society. To be sure, getting involved in politics and health policy is something that many physicians are wary of doing. This is why I first outlined a way to help women that is separate from getting involved in politics. That being said, this fight has been brought to our doorstep, and we risk imperiling our livelihoods if we ignore the issue. Additionally, while the Department of Justice may very well succeed in getting Texas SB 8 struck down, a Pandora’s Box has been opened in the concept of allowing novel assaults on the physician-patient relationship. It is imperative that we as physicians respond forcefully to these egregious threats to our profession. We must first help our patients avoid harm as abortion becomes more restricted in this country. We must push back forcefully against elected officials who work to interfere with the physician/patient relationship. We also need to fight to protect access to full reproductive services for those of us who believe in a woman’s right to choose. We need to speak out to those legislators who will listen and vote out those who won’t. We’ve been pulled into the fray whether we like it or not. It’s time to fight for our livelihoods. Source
